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Careful talk saves lives: improving teamwork in hospital
emergencies

The outcomes of emergency situations in hospitals are greatly
improved if healthcare professionals communicate with each other
effectively. A UWE Bristol research collaboration has helped
achieve this by feeding directly into the content of their
training. Courses have been attended by hundreds of maternity staff
from hospitals across the UK, and have spread around the world.

UWE Bristol research tackles real-world problem

A large proportion of maternal and baby deaths during labour or
delivery could have been prevented with better clinical management
and teamwork. Training hospital staff to work together as
effectively as possible during obstetric emergencies is therefore a
priority. This has been recognised at the highest levels, for
example in a UK House of Commons Health Committee report on
Patient Safety in 2009.

But what exact ways of working together achieve the best
results? What lessons can be learned? These questions have been
addressed by research jointly led by UWE Bristol linguist
Dr Jo Angouri and Dr Dimitrios Siassakos of the University of Bristol, together
with Professor Timothy Draycott and Senior Research Midwife Cathy
Winter from Bristol’s Southmead
Hospital.

Since 2009, they have worked with a multidisciplinary team from
both universities and local hospitals. They investigated how
healthcare professionals communicate with each other, and how this
relates to the outcomes of emergency situations.

The team found that there was better performance when handovers
between staff were structured. This involved stating early on
exactly what the emergency was, followed by the team leader
directing a message to a named individual, who in turn
acknowledged, executed and confirmed the completion of the
task.

Simulated emergencies were videoed in six hospitals. Actors
playing the part of the patient rated the teamwork as better when
there had been an explicit statement of the nature of the
emergency, the condition of the baby and mother, and the treatment
plan to be followed.

Focus groups of healthcare professionals discussing real
emergencies also found that it was crucial to set out clearly the
clinical situation, the patient’s needs and the roles of each of
the team members.

Helping to bring about change

These insights have had a direct effect on the content of
training widely given to maternity staff. They were taken up and
incorporated into a widely used course manual known as PROMPT
(Practical Obstetric Multi-Professional Training) when it was
revised and updated in 2012. They appear in the manual’s chapter on
teamwork.

The manual forms part of a package of training that focuses on
obstetric emergencies. The team’s findings have been used in the
teamwork and leadership sections threaded throughout its practical
sessions.

For example, Southmead Hospital, Bristol, has held
PROMPT ‘train-the-trainers’ courses every
two months. Maternity staff who attended took the package back to
train their colleagues in their own units around the South West of
England and the rest of the UK. By the end of 2013, around 900 professionals
had attended, including obstetricians, anaesthetists and
midwives.

Similar courses held at the Royal College of Obstetricians and
Gynaecologists, London, have also made use of the research
findings and the revised PROMPT manual. By 2013, these courses had trained
208 trainers from 52 UK maternity units, together with further
professionals from around the world.

PROMPT is now being used in the majority of
maternity units in the UK.

Global influence

Use of the updated manual has spread to training in Australia,
New Zealand, China (including Hong Kong), USA, Iceland, Belgium and
Ireland. There are now region-specific versions for the USA, China
and Australia and New Zealand, with further versions in the
pipeline.

The insights gained from the research are therefore making a
real difference on the ground, not just in the UK but also
internationally.